Healing Pelvic Pain: Why Pacing is an Essential Ingredient

By: Julie Sarton, PT, DPT, WCS

How many of us who suffer with either chronic pelvic pain or chronic fatigue have ever pushed ourselves so hard that we are down for the count the next day or even week?

I know I have—too many times to recall. It is so easy to do when we are feeling up to the task. So often, we want to make up for lost time or succumb to the pressures of life, and think we have no other choice but to put the pedal to the metal (until recently, that is, when COVID-19 forced us to slow down!).

What I have learned from my own experience (suffering with chronic fatigue, autoimmune issues and my own severe dysmenorrhea and period pain)—as well as from treating thousands of pelvic pain patients over the last 20 years—is this:

If you ignore your body’s need to find balance in life, your body will talk.

It often will start with a whisper, but if we don’t listen, the body will start to scream to get our attention. We discuss this concept daily in our clinical practice as we treat pelvic pain and sexual pain (and all that accompanies it). Pain is often a messenger our bodies use to communicate. It is often telling us, “Something is off”, “Give me some help”, “Change it up, please!!”.

How we respond can greatly influence our ability to heal.

It is up to each of us to first and foremost choose to listen and discern the message being sent by our bodies. In our pelvic floor physical therapy practice, we often guide patients through this process of listening to what their body is saying. Then, we teach patients to respond to their body’s messaging system by integrating various techniques. The practice of pacing is key to this. Pacing is a critical ingredient to healing on all levels (physically, emotionally and energetically), regardless of what pain syndrome you are suffering with.

Pacing Physically with Pelvic Pain

Pacing physically involves figuring out which amount of activity is the “right” amount of activity—which is unique for every individual. Sometimes, this is discovered through a trial and error process that certainly evolves as the body goes through its various healing stages. Pacing often involves integrating small steps or breaks with a desired activity. The goal is to accomplish more and increase function over time. Pacing is not just about avoiding doing too much. It’s also about staying out of a cycle of doing too little (1).

How to Pace on a Physical Level

So how do we put physical pacing into practice?

When it comes to achieving your desired activity, think about doing a little bit at a time, and spreading out an activity throughout a day. Add a bit more in every other day or every week while avoiding doing too much all at once or before the body is ready. This often requires each patient to monitor his or her activity level so they don’t get lost in their work or functional task (which is easy to do when doing something we love and enjoy)! Using a tracking system or journal is a great way to monitor progress overall. A few clinical examples we often use in our practice is teaching patients how to integrate these principles with their daily total sitting time, daily total walking time or total self-treatment time.

Our pelvic floor clinic happens to treat a lot of patients suffering with pelvic and sexual pain. In fact, one of the specific diagnoses we treat frequently is pudendal neuralgia (patients who suffer with this have severe pain with sitting and at times can’t sit at all). What we classically see is that as patients feel better, they sit for longer periods of time (yeah, this is the goal!); however, if a patient over-does it too quickly or sits too long too soon, the body, the pelvic floor musculature and/or the pudendal nerve can talk. It is important to note that this “talking” does not translate into permanent nerve damage happening as many patients mistakenly believe. It does, however, mean that the perception of pain is increased temporarily.

In other words: At this juncture in time, this person was not ready for that level of total sitting time. Is it possible that in the future, this person will be able to sit for much longer periods in the future without worrying about flaring? For almost all of our patients, the answer is yes!

Let’s dive into a more specific example:

For those who suffer with pudendal neuralgia, they know firsthand that sitting for a total of 6 hours in 1 day is a huge feat!

Joy, a patient from out of the country came to us to be treated for pudendal neuralgia and her inability to sit without pain. After feeling tremendous pain relief with intensive physical therapy, she drove from Orange County to Malibu and back in 1 day for a total of 6 hours of sitting time. For those who suffer with pudendal neuralgia, they know firsthand that sitting for a total of 6 hours in 1 day is a huge feat! However, as her treating clinicians, we suspected that despite this amazing response to physical therapy, her pudendal nerve truly had not had enough time to fully heal—yet. As we anticipated, Joy experienced a temporary relapse in her pudendal nerve pain that rattled her.

However, this increase in pain disappeared about a week later. We also learned that at the same time she increased her sitting, Joy had taken herself off of her neuropathic medication she had been taking due to feeling so good. She came off of her meds cold turkey without guidance by us her physical therapists or her MD, and unfortunately—did not pace to taper down slowly.

Did we believe Joy could sit longer? Yes! Did we want her to see Malibu while in California, visiting all the way from the other side of the world? Yes! Could she have achieved this more successfully by integrating some pacing techniques? Absolutely, yes! Specifically, how? See below for answers.

Joy’s First Recommended Pacing Technique: Hourly Driving Breaks
Stopping every hour to get out of the car and walk, performing her pelvic floor release techniques and other stretches at rest stops would have been awesome pacing in action. Doing too much, too fast increased her pain temporarily. Her nerve responded by saying “I am not ready yet”. Couple this with a drastic and sudden decrease in her medications due to feeling so good, and it was really no surprise that Joy flared the day after her drive.
Joy’s Second Recommended Pacing Technique: Strategic Medication Decrease
A next good step would have been to come off of her medication slowly and steadily. We would have liked to see Joy decrease her medication usage evenly over a period of several days or even weeks, while listening to what her body was saying. Pacing not only applies to what we do physically, but also with decreasing meds (especially neuropathic medications). Slowly, Joy should have come off of the 25 mg of Elvail she was on by first cutting it in half, allowing for her nervous system to adapt. Eventually, she could progress to coming off of it altogether.

The take-home message here is clear: pacing is critical to healing.

It is important to note that no one pace fits all. In general, start small and progressively add new steps. Success breeds success. These small incremental changes add up and over time function and your quality of life will dramatically increase!

One of our beloved male patients who conquered pudendal neuralgia used this John Wooden quote as his guiding philosophy in his healing journey:

“When you improve a little each day, eventually big things occur. Not tomorrow, not the next day, but eventually a big gain is made. Don’t look for the big, quick improvement. Seek the small improvement one day at a time. That’s the only way it happens - and when it happens, it lasts.”

— John Wooden

Sources:

(1) Anna L. Kratz, PhD, Clinical Psychologist and Assistant Professor of Physical Medicine and Rehabilitation at the University of Michigan in Ann Arbor

We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.

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